“Together through ages of the world we have fought the long defeat.”1
— J. R. R. Tolkien

In May 1965, a fire started on the ground floor of the Sound Lumber Company in Arcata, California. Sparks spread quickly through the sawmill, engulfing the “cold deck,” a four million board-foot pile of cut but unfinished logs. The result was an inferno – a blaze that could be seen from miles away, glowing even in daylight. Over a hundred firefighters and civilian volunteers responded from neighboring firefighting divisions and surrounding counties. The fire was devastating – consuming four million gallons of water and causing nearly one million dollars in damage.2

Such a disaster naturally attracted both amateur and professional photographers. Among the hundreds of photographs recorded, one taken by Peter E. Palmquist (1936–2003) stands out for both composition and content. In Humboldt State University’s Special Collections, it is simply designated as “Arcata Mill fire. May 1965.”3

The top two-thirds of the image are dominated by the smoke, flame, and shadow of the cold-decked timber. The once tall trees fade out behind bellowing smoke, obscuring the true size of the fire. Bright specks and dramatic shifts in contrast capture a sense of chaotic movement – the surging roar and crackle. Like misshapen mines in a strange no-man’s-land, “pond lilies” (discarded ends of saw logs) litter the foreground among corrugated piping and the kindling of wood shards and debris, foreshadowing the inevitable fate of the burning logs behind them.

In this clearly dangerous space is an unlikely troupe – nine men, split into three groups. The three men on the left, apparently civilian volunteers in street clothes, appear closest to the fire, likely struggling with the nozzle of their hose, which floats across the photo’s frame. Behind them, centered in the photo, is a group of four. The volunteer at the front of this group faces the flames with an almost confident stance, while the two men behind him crouch down and grit their teeth, enduring but turning away from the intense heat. The figure at the end of this quartet holds his hand to his chin – perhaps to check a fresh burn wound or shield his face. Lastly, two helmeted firemen run in from the right with a second hose. Their conical spray is dwarfed by the waves of flame above them, serving mostly to accent the central four figures. The firefighters’ location behind, rather than before, these civilians is fitting, for much of the power of this photograph lies in watching these ordinary men fight an impossible battle – a long defeat.

Palmquist’s photograph has captured my attention for years. As a historical artifact, the image does not need much back-story for the viewer to conclude that these nine men cannot possibly put out this fire alone. As a work of art (intentional or accidental), the photograph conveys a severe and unexpected beauty. The composition reads like a Caravaggio painting, with great drama of movement, light, and shadow. And as both artifact and art, it invites reflection for our present moment. The image for the most part represents destruction. Yet these ordinary citizens fight on. The photograph depicts the inevitable just as it does the unbelievable – that everyday persons can show extraordinary resiliency and determination in the hellfire of an almost certain failure.

Practicing medicine can often feel like “fighting a long defeat.” Like the curse of Sisyphus, practitioners may find themselves pushing the boulder of health up the high hills of healthcare, only to watch it roll back down to the pits of morbidity and mortality.

For many healthcare workers, “the long defeat” is the endless cold-deck of unfinished paperwork. For others, the ground is peppered by the pond-lilies of “defeat”: unexpected patient losses, misdiagnoses, adverse outcomes, missed career opportunities – even mistakes. For some, the loss is the internal battle of burnout that smolders in the background. For patients, the long destruction might be the chronic condition, the stage four cancer, the relapse, or the inevitability of time.

Perhaps such views betray pessimism – why think in terms of “defeat”? The medical optimist might prefer the uncertain hope of the “Baconian Project,” for it was philosopher-scientist Francis Bacon (1561-1626) who stated that no disease was incurable – calling for the orientation of medical knowledge around the prolongation of life.4 Likewise, the Promethean promises of transhumanism are tempting, claiming that immortality awaits humanity if it can only learn to embrace technology and escape the tinder of biological form. Medicine is not fighting a long defeat so much as fighting for long lives.

But even with better cures, longer living, and growing technology, medicalized immortality is a brittle hope. As philosopher Friedrich Nietzsche (1844–1900) quipped, “death and deathly silence alone are certain.”5 Every eye that beholds Palmquist’s photograph and scans this sentence will die. And in that knowledge, it is difficult not to feel death’s flicker of “dread with an edge of denial.”6

In medical school we are taught the ubiquitous axiom that learning medicine is “like drinking from a fire-hose.” But what do we do when our hands control that hose for the first time, only to find that the fire is too great? How do we practice a resilient, hopeful medicine when we know that every patient we touch or treat will inevitably suffer the slow decay of death?

J. R. R. Tolkien (1892-1973) answers with hope, particularly in the midst of “the silence” of death.7 Indeed, Palmquist’s photograph hints at what Tolkien calls “hope without guarantees.”8 The arts work, in part, to struggle with this human tension between the certainty of death and the peculiarity of hope. As a work of art, this Arcata Mill fire photograph offers more than a cavalier charge to “cheer up and be resilient in the fires of medicine.” Rather, its fire and tenacity move the practitioner to ask of both oneself and one’s patient, “Friend, what do you think about death?” alongside “What do you hope for?”

Patients will always get sick and therefore the good work of medicine will not stop. Fires will begin and end, and some will rage hotter and higher than others. Indeed, many will be devastating. And in this truth is one of the great mysteries and difficulties of the art of medicine – that we must remind our patients, young and old, that they will die, but simultaneously reassure them that the profession of medicine is there to stand at the edge of that flame and fight the long defeat alongside them. In the smoke and shadow of patient suffering, the physician does not promise hope, so much as practice it.9

Maybe Palmquist’s photograph is just a picture of a few adrenaline-soaked friends stumbling through a local disaster, taken at the right place at the right time. Or perhaps there is real inspiration in the sheer grit of human resiliency displayed in the shot – a deep and awful romance in the image of a hopeless firefight – but nothing more. For my own part, I see hope in what happens after the hose has dropped and the fire has devoured and the ash has settled – the foolish, glorious hope of resurrection. However medicine chooses to look at this photograph (or any work of art), it does so among the dying, the hopeful, and those ever in need of hope.

“Keep your mind in hell, and despair not.”10 So opens the memoir of philosopher Gillian Rose (1947-1995), as she dies of ovarian cancer. Whether the practitioner is struggling at the nozzle, standing confidently at the flaming edge, or crouched down under the weight of the heat, the arts can move the healthcare worker to reflect on those habits and practices that allow medicine to keep an eye to the flame and a hand on the hose and “despair not.” As Tolkien writes, “In sorrow we must go, but not in despair.”11 Indeed, the arts call the physician to approach the patient with great trembling and hope, as we, through the ages of the sick, fight the long defeat.

Additional Contributions

The author would like to thank Judith M. Heyhoe (Duke Divinity School) for her editorial comments, as well as Jim Garrison (Humboldt County Historical Society), Carly J. Marino (Humboldt State University Special Collections), Steven A. Munoz (Humboldt State University), Mary Ellen Budney (Yale University Library, Beinecke Rare Book & Manuscript Library), George Miles (Yale Collection of Western Americana, Beinecke Rare Book & Manuscript Library), K. Sarah Krueger (Humboldt Area Foundation), and Pam Mendelsohn for their generous time, research, direction, and conversation.

Nietzsche F. Book Four: Sanctus Januarius. 278. In The Gay Science with a Prelude in Rhymes and an Appendix of Songs. Kaufmann W. trans. New York, NY: Vintage Books; 1974:225.

Popova M. How to Live with Death: Psychoanalyst Adam Phillips on how Darwin and Freud reframed our mortality as an organizing principle of human life. Brain Pickings. 2017. Available at https://www.brainpickings.org/2017/07/10/adam-phillips-darwins-worms-life-death/. Accessed July 17, 2017.

Tolkien J. R. R. The Lord of the Rings, 50th Anniversary Edition. New York, NY: HarperCollins Publishers; 2004:1063. Cited in Mathie A. Tolkien and the Gift of Mortality. First Things. 2003. Available at https://www.firstthings.com/article/2003/11/tolkien-and-the-gift-of-mortality. Accessed July 15, 2017.

Photo source

JOHN BREWER EBERLY JR., MA, is a fourth-year medical student at the University of South Carolina School of Medicine and a fellow of the Theology, Medicine, & Culture Fellowship at Duke Divinity School. His interests include medical student formation, the philosophy of beauty, theological approaches to bioethics, and the medical humanities. He plans to practice obstetrics and gynecology and lives in Columbia, South Carolina, with his wife, Dendy, and son, Jack.